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Michaela Halcomb Archives - Pinnacle III

Aug 29
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Launching an ASC Staff Certification Program

Launching an ASC Staff Certification Program

By ASC Management, Leadership No Comments

When members of your staff indicate they want to get better at their jobs, your response is probably enthusiastic support. After all, a more competent, skilled staff is better prepared to achieve improved clinical and financial results and higher patient and surgeon satisfaction. These are some of the reasons ASCs allocate time and resources to staff training and in-service education. They are also compelling reasons for developing a program that supports ASC staff certification.

ASC Staff Certification Program Components

Here are some of the essential components to address when developing your ASC staff certification program guidelines.

Eligibility

Determine certification program eligibility. Is the program limited to full-time employees or are part-time employees also eligible to participate? Are staff required to work at your ASC for a specific amount of time (e.g., one year) before they are eligible for the program? Will you restrict participation to employees in good-standing?

Acceptable Certifications

Specify which certifications your program will cover – preferably, those that are essential to your facility’s success. Examples of certifications you may want to include:

  • Certified Perioperative Nurse (CNOR)
  • Certified Post Anesthesia Nurse (CPAN)
  • Certified Ambulatory PeriAnesthesia Nurse (CAPA)
  • Certified Surgical Tech (CST)
  • Certified Gastroenterology Registered Nurse (CGRN)

It’s important to permit staff to propose certifications not included in your program. You can weigh the merits and applicability of each proposal. While you may add to your original program list, consider including only those certifications awarded by nationally recognized professional organizations.

Covered Expenses

Identify which expenses are eligible for reimbursement upon successful completion of the ASC staff certification. You will likely want to cover the certification exam fee. You may want to reimburse certification renewal fees. Other expenses to consider:

  • Educational resources to support exam preparation (e.g., books, webinars, conferences)
  • Practice exams
  • Transportation to and from an exam center
  • Continuing education required to maintain the certification

Include a qualifier noting that reimbursement only applies to the portion of eligible expenses not already covered by other payment sources, such as scholarships. Put a cap on the amount of reimbursement available for a single certification and/or timeframe (e.g., annually).

Documentation

Require documentation at the beginning and end of the program. Employees seeking certification assistance should submit their application/request in writing. Following certification program completion, ensure employees provide documentation demonstrating they earned the certification. If you are covering other expenses, request itemized receipts.

Secure a Return on Your Investment

An ASC staff certification program is one way for your ASC to invest in staff. Help protect your investment by including a reimbursement qualifier in your guidelines. State how long employees are expected to remain with your surgery center following completion of, and reimbursement for, the certification program. Clearly outline the financial penalty for failing to reach this mark.

For example, you might require employees to repay 70% of their assistance if they do not stay with your ASC for one year after achieving certification. While you cannot require employees to remain at your center, financial penalties encourage them to thoughtfully consider the impact leaving prior to completion of the qualifying term will have on them and your ASC. Financial qualifiers also deter individuals not fully committed to staying with your ASC from applying to the program.

ASC Staff Certification Program Expansion

If you launch a program that is successful, consider additional ways to encourage staff members to participate. One way is to add certifications to your list. Ask staff for their recommendations. Monitor the development of new certifications, such as the recently launched Certified Ambulatory Infection Preventionist (CAIP).

Another way to expand the program is to go beyond certifications. Include courses provided through an accredited educational institution of higher learning (e.g. college, university, trade or vocational school). These offerings may attract individuals already holding certification(s) or those not interested in certification.

Here are some additional considerations if you are going to offer reimbursement for course tuition:

  • Require the primary business of the institution attended is education. Academic or college credit hours should be earned upon successful completion of the class.
  • Ensure course work is applicable to the employee’s current position or tied to a degree related to an employee’s career path with your ASC.
  • Require proof of completion, such as a transcript or grade report.
  • Determine whether to reimburse for books and other supplies mandated for course participation.

Offering reimbursement for certifications and courses is a potentially low-cost, high-reward method to improve staff performance and productivity. This investment can encourage greater staff loyalty and appreciation of leadership support. An ASC staff certification and educational course program promotes an ASC’s mission of providing compassionate, high-quality care. That’s a proposition easy to endorse!

Michaela Halcomb, Director of Operations

Apr 03
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Implementing a Patient Texting Program at Your ASC

Implementing a Patient Texting Program at Your ASC

By ASC Development, ASC Management No Comments

Over the last two decades, texting has grown into one of the world’s most effective and accessible communication methods. However, there are still some professional service sectors where more traditional communication (e.g. phone, mail) is more common. It may be surprising to know that some health care entities are beginning to offer patient texting programs, sending important reminders to patients. For those in the ASC industry, this is an exciting opportunity to demonstrate to patients you care about modernizing and updating their delivery of care as well as your interactions with them. Is your ASC poised to take advantage of this chance to show you provide the best and most convenient options?

Here are a few interesting statistics about smartphone and text messaging use:

  • Ninety-five percent of Americans own a cellphone of some kind.[1]
  • Texting is the most widely used smartphone feature, with 97% of Americans using it at least once a day.[2]
  • Ninety percent of all text messages are read within three minutes of their delivery.[3]
  • It takes the average person 90 seconds to respond to a text message.[4]
  • Texting is for everyone. Ninety-four percent of smartphone users 70 and older use text messaging on a weekly basis.[5]

Statistics like these helped inspire our ASC to implement a patient texting program in November 2017. Before launching the program, many of our patients were receptive to the idea of receiving text messages from our ASC. As part of our program, patients are asked if they want to receive text messages from us when providing their medical history through our online portal. An average of about 80 percent of our patients opt in.

We hoped that by leveraging the power of texting, we could improve the experience of our patients and staff.

Developing the Texting Program

Our texting program is managed through an online patient portal vendor. Working with this company, we customized a series of automatic text messages which are sent to patients preoperatively and on the day of surgery. We carefully crafted our messaging and determined the most appropriate time for message transmissions. This “automated clinical pathway” provides instructions and prompts patients to complete important steps in their procedure preparation. Personal health information is never transmitted to maintain HIPAA compliance.

Here is a summary of our text messages:

Two days before surgery, morning. Our first message asks patients to confirm the date and time of their procedure.

If patients are unable to make their appointment, the message advises patients how to reschedule.

If patients confirm their appointment, they receive another automated message reminding them to review their physician’s preoperative instructions.

Two days before surgery, evening. This message provides instructions about what patients need to bring with them on their day of surgery. We also remind them to bring a method of payment and ensure they arrange for transportation.

Day after surgery, morning. Our final automated message thanks patients for allowing our ASC to provide care during their surgery. It also expresses our hope that they are recovering well. If there is a problem with their recovery, the text message instructs patients to call the ASC and ask to speak to a nurse.

Note: Patients can opt out of receiving texts from the ASC at any time. For patients who choose to do so, and those who do not opt in to receiving texts when providing their medical history, we communicate via phone and/or email.

Texting Program Benefits

Due to the widespread use of text messaging, patient texting programs are primed for success. During the first three months of this program at our ASC (November 2017-January 2018), all patients who opted to receive text messages responded to the automated messages. Most confirmed their appointment through the text message; the remaining called the ASC.

Here are some of the tangible improvements your ASC may experience after implementing an ASC patient texting program:

  • Decrease in number and duration of nurse calls to patients (savings of about 10 minutes per call)
  • Decrease in staff hours per case
  • Increase in staff efficiency and satisfaction
  • Increase in patient compliance with physician and ASC instructions
  • Decrease in patient no-shows and cancellations
  • Increase in patients paying for care prior to day of surgery (an unexpected benefit)

Growing the Patient Texting Program

After experiencing the success of a patient texting program, ASCs may consider exploring ways to expand the use of texting. One idea is to incorporate front office staff into the patient texting program. For example, after verifying benefits, front office staff may choose to send an automated text message to patients. The message could indicate patient financial responsibility after verified insurance deductions, and prompt the patient to arrange for payment.

Another solution is sending a one-time text message to patients. This would come in handy if, for example, there was a significant snow storm or catastrophic event and the ASC needed to close. The ASC could send a text to all affected patients on the surgical schedule.

One other area to grow a patient texting program is sending text updates to family members in the waiting area. These would provide an update on the status of loved ones in surgery.

The Importance of a Patient Texting Program

An ASC patient texting program demonstrates to patients your ASC cares about consistently modernizing and updating your health care services with a focus on what works best for patients. This is a powerful message to send to your customers in the ASC industry. Studies show 64 percent of consumers prefer texting versus a phone call for customer service needs and 77 percent of consumers are likely to have a positive perception of companies that use text messaging.[6] In the ever-changing health care market, texting is expected to become an even more valuable communication tool going forward. You can bookmark this as a 2018 ASC industry trend.

Michaela Halcomb, Director of Operations

[1] http://www.pewinternet.org/fact-sheet/mobile/

[2] http://www.pewinternet.org/2015/04/01/us-smartphone-use-in-2015/

[3] http://connectmogul.com/2013/03/texting-statistics/

[4] https://www.ctia.org/

[5] https://www.tatango.com/blog/94-of-seniors-are-sending-text-messages-weekly/

[6] https://www.openmarket.com/blog/infographic-consumers-favor-sms-messaging-yet-online-retailers-are-missing-the-massive-opportunity-to-engage/

Dec 28
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The Ripple Effect of Reducing Data Entry Errors

The Ripple Effect of Reducing Data Entry Errors

By ASC Management, Leadership, Revenue Cycle Management No Comments

When claims are denied due to data entry errors made during patient registration, a ripple effect occurs. Payments are delayed, increasing accounts receivable days. Back office billing personnel must work with front desk staff to obtain corrected data, then resubmit claims, wasting precious time. Staff may blame one another for the errors, damaging employee morale and creating an unpleasant work environment. If denied claims build up, the potential to miss important follow up grows and valuable revenue can go uncollected. Profit margins decrease and ownership distributions suffer.

These were all concerns of mine when I faced my ASC’s data entry error rate of nearly 11% in January. I knew we could do better. We had to. So, I set a goal for our front desk staff: to reduce their data entry error rate to below 1%.

In August, we achieved that goal. Our error rate is currently 0.69%. Staff want to further reduce their errors. Given their determination and effort to achieve what they have, I believe they can accomplish any goal they set for themselves.

Here are some of the steps we took to achieve this impressive turnaround.

Review and Analyze Data Entry Error Log

Accountability is critical when striving to improve. To ensure we maintained momentum, we implemented weekly reviews of our data entry error logs. During these reviews, we evaluated each error to identify the cause. We then discussed what staff needed to do to avoid making similar errors in the future.

For example, we noticed our team made similar insurance errors month after month. Some of the errors related to not clearly identifying payers. Others were steeped in confusion around different plan types offered by a single payer. To reduce these errors, we printed examples of our most common insurance cards, highlighting key details needed by registration staff on the front and back of those cards. Laminating these examples provided staff with “cheat sheets” that helped improve accurate entry of insurance details.

Data Entry Double Check

Each morning, an assigned member of the front desk team printed out the schedule of the previous day’s cases. This individual then double-checked that patient data in our registration system to ensure accuracy. To minimize interruptions and distractions, this review was performed in a private office.

Staff also sought out opportunities to perform data checks during the registration process, particularly concerning error-prone areas. For example, the subscriber date of birth was a troublesome data set. When the patient is not the subscriber, both dates of birth (patient and subscriber) need to be recorded. These repetitive reviews helped our team increase data entry accuracy.

Front Desk Staff Input

To help further secure performance improvement, we frequently asked front desk personnel to share their ideas. After all, working these accounts every day gave them insight into areas leadership did not have. We carved out time during our meetings for staff to share thoughts and let us know where help was needed. We worked on fostering an environment where they felt free to express themselves and ask questions.

These meetings and conversations allowed leadership and staff to develop a closer relationship. I maintain an open-door policy. Staff are comfortable speaking with me outside of meetings which allows us to quickly respond to opportunities to make positive change.

To help our front desk team members succeed, we regularly ask if they have the tools they need to perform their jobs effectively. We are happy to honor requests when we understand how doing so will bring about improvements

Ongoing Front Desk Staff Meetings

Once our front desk staff achieved the data error entry rate goal and demonstrated an ability to maintain it, we didn’t stop our meetings. Rather, we decreased meeting frequency from weekly to monthly. Our monthly meetings provide us with time to review and discuss a summary of the previous month’s data entry error reports. Error trends are now a rarity. Our vigilance ensures new trends aren’t developing and significant time isn’t passing without detection of potential troublesome areas.

Eye on the Prize

Ongoing updates on performance is the primary reason our front desk team members were so successful in lowering their data entry error rate. As we instituted improvements, they anxiously awaited delivery of the next data entry error log. They wanted to gauge their performance and find out if their hard work was achieving the desired results. Disappointment set in when the error rate did not decline or drop as much as they hoped. Fortunately, they used their disappointment as motivation to be proactive and seek additional opportunities for improvement.

I see tremendous value in providing our front desk staff with achievable, measurable goals. This team is now working on a new objective – capturing information about patients’ primary employers. Because this is a new process for them, team members occasionally fail to capture this information. We evaluate staff performance in this area monthly and work to determine reasons why our capture rate is not 100%. That’s our goal, and we know it’s obtainable. Why? Because it is a figure achieved by other Pinnacle III managed facilities, and our staff knows it. Now there’s some friendly competition between facilities.

The Ripple Effect

The positive ripple effect our ASC experienced when our front desk team reduced their data entry error rate to less than 1% was significant.

  • In January, when our error rate was 11%, our average accounts receivable (A/R) days was 28. When we reduced the error rate to 0.69% in August, our average A/R days decreased to 20.
  • Our claims-to-payment days declined – from 34 days in the first quarter of 2017 to 31 days in the third quarter.
  • We experienced a reduction in bad debt – from 4% at the end of 3rd quarter 2016 to 3% during the same timeframe in 2017. While the drop in bad debt is attributable to the improved efforts around upfront collections, it underscores how focusing on troublesome performance indicators can produce meaningful change.

Financial improvements have not been the sole byproduct, however. A transformation has occurred among our front desk personnel.

  • They are more engaged and eager to learn about their performance.
  • They more fully understand how their efforts affect our facility which motivates them to continuously strive for excellence.
  • Their relationship with leadership is truly collaborative.
  • Our governing board, which reviews the financial data, has expressed pride in and appreciation of front desk staff performance.

My concern with the damaging ripple effect that could have occurred when our data entry error rate was 11% subsided as progress was made by our front desk team. Our focus on, and improvement in, this area has made a difference. Our ASC operations were positively transformed in a sustainable way.

Michaela Halcomb, Director of Operations

Sep 19
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2017 OAS CAHPS: Should Your ASC Implement CMS’ Survey in 2017?

2017 OAS CAHPS: Should Your ASC Implement CMS’ Survey in 2017?

By ASC Management, Payor Contracting No Comments

The Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Provider and Systems (OAS CAHPS) collects information about patients’ experiences of care in ambulatory surgery centers (ASCs) and hospital outpatient departments (HOPDs). The survey gathers patient perceptions related to communication and care provided by surgery staff, expectations prior to surgery, and planning related to discharge and recovery. Enforced implementation of the survey has been delayed until 2018, with the specific date being released this November. Surgery centers across the country are deciding if they should implement the survey as planned, or wait until the Centers for Medicare and Medicaid Services (CMS) begins enforcing survey implementation.

To assist in decision making, it’s helpful to review information regarding the OAS CAHPS Survey.

Why is CMS developing this survey?

  1. The number of ASCs has increased considerably in recent years as has the surgical case volume at both ASCs and HOPDs.
  2. Medicare expenditures from outpatient surgical sites for ASCs and HOPDs also continues to rise.
  3. Implementation of OAS CAHPS will provide CMS with statistically valid data on the patient experience to inform quality improvement and comparative consumer information about outpatient surgery facilities.

The results of the OAS CAHPS will be used to:

  1. Provide CMS with information for monitoring and public reporting purposes,
  2. Provide a source of information enabling prospective patients to make informed decisions in outpatient surgery facility selection, and
  3. Aid facilities with their internal quality improvement efforts and external benchmarking comparatively with other facilities.

What modes are available to administer the OAS CAHPS?

  1. Mail only
  2. Telephone only
  3. Mixed mode (mail survey with telephone follow-up of non-respondents)
  4. An electronic mode of surveying is currently under review.

How often is the OAS CAHPS administered?

  1. Surveys are administered on an ongoing basis.
  2. An annual minimum of 300 surveys must be completed for each facility.
  3. Participating facilities will provide a monthly sample of patients who received at least one surgery or procedure during the sample month to their survey vendor.
  4. Vendors will initiate surveys within three weeks after the sample month closes.
  5. Once a survey has been initiated it must be completed within six weeks.

The OAS CAHPS may be administered in conjunction with other surveys but sampling methods need to be followed to ensure patients are not overburdened by multiple surveys.

  1. For each sample month, the survey vendor must select the OAS CAHPS sample prior to selecting the samples for any other ASC survey.
  2. The ASCs cannot select the sample for any other facility survey they may choose to implement.
  3. The vendor must select the sample because the sample selection for OAS CAHPS cannot be disclosed to the facility.

OAS CAHPS Survey Implementation

  1. National voluntary implementation began in January 2016 with required participation scheduled to begin January 2018. CMS has proposed delaying implementation of the mandated 2018 date. The decision will be released in Medicare’s final 2018 ASC payment rule this November.
  2. It is unlikely the delay will be permanent because CAHPS surveys are already mandated in hospitals, home health, hospice, and dialysis centers.
  3. ASCs that have voluntarily participated in OAS CAHPS have received valuable information about the quality of outpatient care provided at their facility.

There are pros and cons to implementing the survey now versus waiting until CMS mandates the survey next year. It is often better to prepare early. What should administrators consider in determining what is best for their center?

Reasons to delay the OAS CAHPS Survey until 2018:

  1. Financial and administrative burden of submitting the data.
  2. Decision on the electronic survey mode option.

Reasons to implement the OAS CAHPS Survey now:

  1. You will know where your surgery center stands before mandatory reporting begins.
  2. You will have an opportunity to address identified issues for improved survey results.
  3. You can learn and understand your patients’ perceptions and make changes to increase overall satisfaction.
  4. Post-discharge surveying allows for a better assessment of the entire surgery process.

Peak One Surgery Center located in Frisco, Colorado has chosen to move forward with implementation of the OAS CAHPS survey now. It was an easy decision for us because it will allow us to get ahead of the competition. We can build out processes with our vendor and adjust our internal reporting systems. There will also be time for staff, physicians, and administration to learn the program. When my fellow administrators ask, I advise them to begin work with a vendor on voluntary implementation of the OAS CAHPS survey to avoid being at a disadvantage when the survey becomes mandatory.

Michaela Halcomb, Director of Operations